AN UNCOMMON GIFT

25 years of matching patients and life-saving unrelated bone marrow donors in the Rainbow Nation

Every year hundreds of South Africans with blood diseases such as leukaemia and bone marrow failure reach a stage where their only chance of survival is receiving a bone marrow stem cell transplant from a healthy donor. This year, the South African Bone Marrow Registry (SABMR) – the only bone marrow registry in South Africa – is celebrating 25 years of successfully securing bone marrow stem cell transplants for 383 patients.

According to the SABMR, approximately 30% of patients find a match within their families whilst the other 70% rely on finding a match from an unrelated donor to provide them with the chance of survival. The SABMR currently has 72 000 registered bone marrow donors on its database and the chance of finding a match for a patient diagnosed with a blood disease is one in 100 000, which makes South African based donor recruitment essential.

Comments Dr Charlotte Ingram, Medical Director of SABMR: “Bone marrow is the tissue that produces red blood cells to carry oxygen, white blood cells to fight infection and platelets to prevent bleeding – all required to sustain life. The transplanted cells taken from the donor replace the recipient’s cancerous cells that have been destroyed by chemotherapy and these healthy cells then produce the new red and white blood cells, as well as platelets.”

While blood diseases are not limited to age, gender or race, the ethnic background of a donor is crucial to finding the perfect match. The ethnic origin of a match plays a significant role as a match is based on inherited genetic characteristics which are often associated with a particular race group and not on blood types. Through association with the World Marrow Donor Association (WMDA) and participation in Bone Marrow Donors Worldwide (BMDW), the SABMR has access to 28 million donors worldwide, however getting stem cells from international donors is very costly.

Dr Ingram continues: “Since using an overseas donor is expensive, patients who cannot find a local donor may not be able to afford a bone marrow transplant from an international source – making their chance of survival slim. We need more South Africans to register so we can save more lives, and we are in desperate need of more Black donors. In 2015, there were 150 preliminary donor search requests for patients needing a bone marrow transplant. Fifty percent of the referrals were for patients who are Black, Coloured or Asian whilst only three out of the 25 patients transplanted in that year were in this group.”

Because South Africa is a Rainbow Nation there is a need for a large culturally diverse database of prospective stem cell donors in order for all patients to have the opportunity of finding a life-saving match. The first Black South African to donate stem cells to an unrelated patient – Brenda Masuku, the youngest of eight children from a village in Mpumalanga – did so in 2003, and describes the experience as “life changing”.

Comments Masuku: “I am the only member of my family who has ever donated blood because it is not usual in Black South African culture to do so, let alone to become a stem cell donor. In 1999, a group of my colleagues were going to participate in a bone marrow drive for a South African boy who had leukaemia and they urged me to join them. Following my registration I changed jobs and cell phone numbers, making it impossible for the SABMR to contact me. One day I had an urge to call my previous boss to say ‘hi’ and I was taken aback when he told me the SABMR was attempting to locate me. If I had not called, the SABMR would never have reached me.”

A bone marrow transplant is a very unique procedure as an individual’s immune system is destroyed and replaced with one from an unrelated person in the general population who happens to be a perfect match.

Dr Ingram adds: “If a potential donor is identified in the preliminary stage then the search is activated. In this phase, more detailed testing will be arranged and if after the additional testing the donor is found to be suitable match, the patient can then proceed to transplantation.”

The process of donating bone marrow is very similar to donating blood platelets. Blood, drawn via a needle in one arm, gets filtered through a cell separator machine which deposits bone marrow stem cells into a bag. The rest of the blood is returned via a needle in the other arm. This process takes approximately four to six hours and might need to be done over two consecutive days. The bag of stem cells will then be used to perform the patient’s life-saving bone marrow stem cell transplant.

Masuku shares further on her experience: “When I first heard I was a match for Ashley Wilder, a young African-American girl living in Lancaster, California, I was excited to help. Although I was contacted about being a match for Ashley in 2000, she was in remission and wasn’t in need of a transplant at that stage. Sadly, Ashley suffered a relapse in 2003 resulting in her needing an urgent bone marrow transplant; thankfully I was on standby and ready to help. I was incredibly nervous about the procedure but it turned out to be very easy. I hope my story inspires other black South Africans to become donors and help save someone’s life.”

Dr Ingram concludes: “Considering the hope that has been offered to so many patients along the way, we are extremely pleased to be celebrating 25 years of finding unrelated donors for South African patients in need of a bone marrow transplant. Our goal is to continue growing our database in order to save more people’s lives. As such, we encourage each South African in our Rainbow Nation to register to become a committed donor and offer someone this uncommon but life-saving gift.”